https://doi.org/10.4081/aiua.2026.14954
Comparison of intraoperative and postoperative results after tricomponent penile prosthesis implantation under spinal versus local anaesthesia
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Published: 20 May 2026
Background: The aim of this paper was to compare the intraoperative and postoperative outcomes of two similar groups of patients who underwent three-component penile prosthesis implantation under spinal versus local anaesthesia.
Materials and methods: We reviewed retrospectively the medical records of twenty consecutive patients who underwent three-component penile prosthesis implantation for erectile dysfunction under spinal anaesthesia (S-PPI) versus local anaesthesia (L-PPI) in the period between January 2023 and January 2025. As regards the assessment of the pain, the patient’s requests of sedation due to pain complaining during the induction of the anesthesia and the following surgical procedure were assessed. The Visual Analogue Scale (VAS) was also used for pain assessment six hours and one day after the surgical procedure. A modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) validated questionnaire was used to evaluate patient satisfaction after the prosthesis implantation. Perioperative and postoperative complications were also assessed.
Results: There was no statistical difference in terms of age, BMI and etiology of erectile dysfunction among the two groups. As regards the assessment of the pain, a significantly higher request of sedation was assessed in the S-PPI group than in the L-PPI group of patients (10% versus 40%) due to discomfort during the local anaesthesia or the surgical procedure (p < 0.05). On the contrary, mean VAS scores of 6.0 and 6.5, 5.5 and 5 were reported by the S-PPI and L-PPI groups at 6 and 24 hours after surgery respectively, showing a similar degree of postoperative pain among the two groups of patients. The EDITS questionnaire scores showed no significant difference between the two groups in terms of patient satisfaction. As regards the complications, no significant difference was assessed between the two groups of patients.
Conclusions: Our preliminary outcomes showed that a threecomponent penile prosthesis implantation under local anesthesia can be successfully performed in terms of postoperative pain control, acceptable complication rates and remarkable satisfaction scores with respect to the same procedure under spinal anaesthesia. Concerning the perioperative pain control, a significantly higher request of sedation was reported in the L-PPI group of patients with respect to the S-PPI group due to discomfort during the induction of local anesthesia or the implant procedure. Basing on these aspects, we think that a three-component penile prosthesis implantation in local anaesthesia could be proposed in selected patients with comorbidities which contraindicated spinal or general anesthesia or in patients unwilling to undergo these types of anesthesia after a preoperative counselling regarding the pain control and the possible need of sedation.
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Bettocchi C, Palumbo F, Spilotros M, et al. Penile prostheses. Ther Adv Urol. 2010 Feb;2(1):35-40. DOI: https://doi.org/10.1177/1756287209359174
Chierigo F, Capogrosso P, Dehò F, et al. Long-Term Follow-Up After Penile Prosthesis Implantation-Survival and Quality of Life Outcomes. J Sex Maed. 2019 Nov;16(11):1827-1833. DOI: https://doi.org/10.1016/j.jsxm.2019.08.001
Akdemir F, Okulu E, Kayıgil Ö. Long-term outcomes of AMS Spectra® penile prosthesis implantation and satisfaction rates. Int J Impot Res. 2017 Sep;29(5):184-188. DOI: https://doi.org/10.1038/ijir.2017.16
Otero JR, Rojas. Penile implantation in Europe: successes and complications with 253 implants in Italy and Germany. J Sex Med 2008;5:1503-1512. DOI: https://doi.org/10.1111/j.1743-6109.2008.00819.x
Ji YS, Ko YH, Song PH, et al. Long-term survival and patient satisfaction with inflatable penile prosthesis for the treatment of erectile dysfunction. Korean J Urol 2015;56:461-465. DOI: https://doi.org/10.4111/kju.2015.56.6.461
Hellstrom W, Montague DK, Moncada I, et al. Implants, me- chanical devices, and vascular surgery for erectile dysfunction. J Sex Med 2010;7:501-523. DOI: https://doi.org/10.1111/j.1743-6109.2009.01626.x
Corona G, Santi D, Cocci A, et al. Long-term penile prosthesis couple's satisfaction: A systematic review and meta-analysis.Andrology. 2025 Mar;13(3):610-623. DOI: https://doi.org/10.1111/andr.13696
Scherzer ND, Dick B, Gabrielson AT, et al. Penile Prosthesis Complications: Planning, Prevention, and Decision Making. Sex Med Rev. 2019 Apr;7(2):349-359. DOI: https://doi.org/10.1016/j.sxmr.2018.04.002
Ghanem H, Fouad G. Penile prosthesis surgery under local penile block anaesthesia via the infrapubic space. Int J Androl. 2000 Dec;23(6):357-359. DOI: https://doi.org/10.1046/j.1365-2605.2000.00251.x
Kaufman JJ. Penile prosthetic surgery under local anesthesia. J Urol. 1982 Dec;128(6):1190-1191. DOI: https://doi.org/10.1016/S0022-5347(17)53416-3
Dos Reis JM, Glina S, Da Silva MF, Furlan V. Penile prosthesis surgery with the patient under local regional anesthesia. J Urol. 1993 Oct;150(4):1179-1181. DOI: https://doi.org/10.1016/S0022-5347(17)35719-1
Cotta BH, Welliver C, Brahmamdam A, et al. Long-acting liposomal bupivacaine decreases inpatient narcotic requirements in men undergoing penile prosthesis implantation. Türk Ürol DergisiTurkish J Urol 2016; 42:230–234. DOI: https://doi.org/10.5152/tud.2016.44442
De Rose AF, Gallo F, Giua D. Three-Component Penile Prosthesis Implantation Under Completely Local Anesthesia: A Case Report. Int J Surg 2024; 11 (1): 2-4
Huskisson E: Measurement of pain. Lancet 1974; 304:1127- 1131 DOI: https://doi.org/10.1016/S0140-6736(74)90884-8
Althof SE, Corty EW, Levine SB, et al. EDITS: development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction. Urology 1999;53:793-9. DOI: https://doi.org/10.1016/S0090-4295(98)00582-2
Weech D, Amber MA, Ashurst JV. Anatomy, Abdomen and Pelvis, Penis Dorsal Nerve. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.
Xie D, Nicholson M, Azaiza M, et al. Effect of operative local anesthesia on postoperative pain outcomes of inflatable penile prosthesis: prospective comparison of two medications. Int J Impot Res 2018; 30:93–96. DOI: https://doi.org/10.1038/s41443-018-0025-7
CRediT authorship contribution
AFDR: study concept, contribution to manuscript writing and editing
GF: data analysis and interpretation, manuscript original drafting, contribution to manuscript writing and editing
GM: contribution to manuscript editing
DG: data analysis and interpratation, contribution to manuscript writing and editing
MS: contribution to manuscript writing and editing
Supporting Agencies
Data Availability Statement
The authors reviewed the medical records of twenty consecutive patients who underwent surgery at Villa Montallegro Hospital by the same surgical team.
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